KETOSIS
or
PREGNANCY TOXEMIA

[Note: In this article the term "Pregnancy Toxemia" (or simply "Toxemia") and the word "Ketosis" are used interchangeably.]

In the spring of 2005 we were anxiously awaiting the birth of NK M141 Kattie's babies. We had purchased Kattie, and she almost immediately gave us Samantha and Thunderbolt. In March 2004 we used Kattie as the donor doe for our flush. These 2005 babies would be her first after the flush and hernia repair.

All was going well; Kattie (already a large doe) was getting bigger and bigger by the day. About 15 days before her due date, we noticed she was laying around all the time. We figured as heavy as she was with the pregnancy, walking just wasn't comfortable.

Knowing Ketosis (excessive ketone levels in the blood - a medical condition caused by abnormally high levels of ketone bodies in the blood resulting from the metabolism of fats instead of carbohydrates for energy) was a possibility, we started dosing her with Magic.

10 days before her due date, Kattie (and her 4 kids) died. The two boys and two girls weighed a total of 28 pounds.

Hindsight is perfect.

After her death we realized that when Kattie started laying around and not walking, she also quit going to the water. We also realized we had not started treating her soon enough – or aggressively enough.

The day Kattie died another doe who was due in 10 days delivered a healthy 9 pound little girl. We should have induced labor – but we had always read where kids born more than 5 days early were considered premies and the survival chance was slim.

Fast forward to 2006.

We purchased Melissa at a production sale in July 2005. In September 2005 we bred her to a friend's buck (who was purchased at the same sale). This combination just had to produce some fabulous kids!!

Melissa, who would turn 2 on 9 February 2006 and who had never kidded, was a large-framed doe. Her due date was 13 February. So on 22 January, approximately 3 weeks before her due date, we gave her the pre-kidding shots of BoSe (because we are in a selenium deficient area), Covexin 8, Super Poly Bac B Somnus (to protect against pneumonia), and Vitamin A,D,E. On the same date we trimmed her hooves – but not very close.

After Melissa returned to the barn, we noticed she was lifting her front feet as though they hurt. We were sure we hadn't trimmed too closely. The next couple days Melissa always looked like her feet pained her. We didn't notice if she was eating as usual; Melissa was in such good shape we weren't really concerned about her. But by Wednesday she appeared to be walking on egg shells. Something more needed to be done.

We took her temperature; it was normal. We started bringing her into the feed room so she could eat whatever she wanted uninterrupted (well, as uninterrupted as one can be with 5 little kids bouncing off the walls of the feed room). We checked her feet again to make sure we hadn't missed something. And that was when we noticed how swollen her legs were.

Ketosis! It appeared that aggressive treatment was necessary. We immediately started giving her Magic!

We contacted a friend (Coni Ross) who suggested we give her Calcium Gluconate just in case she had hypocalcaemia and needed a calcium boost. Our friend also suggested we give her a scoop of corn to increase her sugar level and give her energy. We were also reminded to give her Calf Pac (a probiotic) to keep her rumen functioning properly. And we were instructed to feed her all the alfalfa hay we could get her to eat.

Unlike Kattie, Melissa continued to go out to the hay field with the rest of the herd every day. Since she appeared to be in a slightly weakened state, we decided to keep her in the creeper at night where the other goats couldn't beat her up (something the others wouldn't consider doing if she felt good because she was among the largest of our does). By being in the creeper with everybody else locked out, she would be able to eat all she wanted whenever she wanted, and she could have corn which the rest of our herd is not fed. We were able to put water in the creeper so she could have plenty of fresh water to drink whenever she needed it.

By Sunday we were getting more concerned. We had added Dextrose and cranberry juice to our list of things to give Melissa, as we noted she wasn't drinking much of her water and she wasn't eating any of the feed/corn we had out for her. And she was losing weight. Her temperature was 103.

When we noticed the 2 inch string of fluid, we decided to call our vet, Dr. Wyatt Galbraith, who said he would be right out. We did not want her to go into labor so soon.

The first thing he noticed about her was the rattle in her chest. Pneumonia. He gave her an antihistamine shot along with Banamine for pain. In addition, we gave her Nuflor for the respiratory discomfort. He agreed with our treatment with the Magic, Keto Gel, and Calcium Gel – and also agreed she needed more in the way of nutrients. He proceeded to tube her with ½ bottle of 50% Dextrose, ½ bottle of Pedialyte, and about 8 oz. of water. He drew blood to check her sugar level; it was 40; the minimum for a goat is 60.

We repeated the antihistamine, Banamine, and Nuflor on Monday – along with all her other items.

Melissa continued to go out into the field during the day to graze/browse (although at this time of year there isn't much of either in Tennessee). She no longer seemed to be walking on egg shells and was getting around pretty good.

Tuesday evening she had a 12 inch string of mucus; we were concerned that birth was imminent and carried our stash of old, but clean, towels to the barn to be ready. We were still very concerned because she was still 13 days away from her due date.

Wednesday Melissa went out with the herd as normal, but she no longer could keep up with them and had a hard time getting back to the barn. She was going downhill fast, and we were at a loss as to what else we could do for her.

So, the vet was summoned again. He suggested we start her on an IV and induce labor if we wanted to save Melissa. He arrived at 8 p.m.; Melissa was already in labor without being induced. But she was so weak by this time, she could not push to move the babies into the birth canal. By 9 p.m. Wyatt was able to deliver triplets – 2 girls and 1 boy. Unfortunately all three were born dead.

He started the IV (lactate ringers, 1000 mL) at 9 with a fairly fast drip. He also gave her an antibiotic and a shot for pain. She never flinched. Under his direction, we hooked up a heat lamp because he felt she would be chilled (temperature was well below freezing by this time). Just for good measure, we covered her with an old Army blanket to try to help her retain some warmth. When the first bag was empty, we started a second bag with a slower drip. Afraid she would pull the IV loose, we stayed in the creeper with her until well after midnight when the second bag was empty.

Melissa died between 5 and 6 a.m.

Apparently we are slow learners. Approximately 3 weeks later we noticed another doe walking gingerly and laying around a lot. Quartz, too, was about 3 weeks from kidding and had her pre-kidding shots. Quartz, though, wasn't a large doe. In fact, she was one of our smaller South African fullbloods with a condition code of 5 (on a 9-point scale). Her first kidding had produced relatively small (5 and 6 pounds) kids while her second kidding produced a single, healthy girl born 10 days early. Quartz was still eating well, drinking well, and was still going out to graze/browse with the other goats.

But with Melissa still heavily on our minds, we tested Quartz with the Ketone Strips. And we were totally shocked when we learned she had extreme ketosis! Treatment began immediately.

15 days before her due date, Quartz, whose ketone levels had returned to normal, died. She was carrying quads – 3 girls and 1 boy. 32 pounds of kids in her relatively small body. Quartz definitely disproved the theory that ketosis is restricted to overweight or poorly fed goats.

Still we didn't learn. Approximately a month before Beauty was due to kid, she started laying around a lot. Now, it was 100 degrees, and a lot of the goats were laying around a lot – bred and not bred – so we weren't too concerned. Finally Beauty, one of our less tame goats, was slow enough for us to catch. A quick check of her eyes indicated she needed to be wormed, so we did that before going out of town for a show. Beauty had not lost any conditioning, so we decided her only problem was a heavy parasite load. We were wrong.

When we returned from 2 days away from the farm, Beauty was down. We thought it was anemia, so we treated her aggressively with Magic, iron shots, and vitamins. Since she had not lost conditioning, had not stopped eating, and since she was not overweight, it didn't occur to us to test her for ketones – until it was too late to help her. Beauty, in her first pregnancy, was carrying twins. She died 15 days before her due date.

The moral of this little story: Ketosis must be recognized early and treated aggressively from the beginning.

Losing four outstanding does to ketosis forced us to do research on the disease and change our management practices with pregnant does.

The first step we took was to purchase an ultrasound machine so we will know how many fetuses a doe is supporting.

Ketosis/pregnancy toxemia is more prevalent in large does carrying multiple fetuses.

But, while it is more prevalent, multiple fetuses are not a definite "sign." The only way to know for sure if a doe has ketosis is to test with Ketone strips - readily available at the local drug store.

Ketosis/pregnancy toxemia seems most likely to occur in the last 3, 4, 5, or 6 weeks of pregnancy (depending on which article you read). According to one source, before a doe kids it is pregnancy toxemia but after she kids it is ketosis.

The second step we took was to change feed during the later stages of pregnancy. After the first 45 days of the pregnancy, we have switched the bred does from 18% protein in the Co-Op Goat Starter to a 14% protein Farm and Ranch 14 Pellet for beef cattle on pasture, maintenance of mature horses, and finishing goats. In our research we learned goats need less protein and more starch (energy) in the latter stages of pregnancy. This did not seem to work, so we found Feed in a Drum, which is a molassas-based mineral/protein supplement. The does love. Since we added the supplement, five does kidded with triplets with no sign of ketosis.

Ketosis/pregnancy toxemia is better prevented than treated. Note: we did not say easier to prevent than treat. It has been suggested to prevent toxemia you should not have fat does during early pregnancy and increase the caloric intake in late pregnancy by providing a feed high in energy – all the while eliminating stress on the doe. That sounds so easy, but we have does who gain weight by smelling feed. And increasing the caloric intake is difficult when the doe quits eating due to lack of space around her rumen.

The third step we have not had to take yet. We have vowed though, that in the future, if we have a goat with ketosis, we will immediately induce labor and abort the pregnancy. If the doe can be saved, she can have more kids. If the doe is within two weeks of delivery, we will induce labor by giving 20-25 mg. dexemethasone;and labor should begin within 48 hours. (The dexamethasone, according to Dr. Laird Laurence, will increase the survival chance of a kid.)

Ketosis is a condition characterized by an abnormally elevated concentration of ketones in the body tissues and fluids. (Ketones are acetoacetic acid and beta-hydroxybutyric acid.) It is a complication of starvation. (Dorland, 27th ed) The babies take up so much room in the doe's body there is no room for the rumen to function properly. The doe's body, due to lack of food (starvation) starts breaking down stored fat (and with most goats there is very little fat stored) to convert to sugar.

During late pregnancy, the level of nutrients required by the doe are high – as high as during lactation. But the developing fetuses crowd the abdominal cavity, reducing volume used by the rumen. According to J. M. Luginbuhl and M. H. Poore,
http://www.cals.ncsu.edu/an_sci/extension/animal/meatgoat/MGNutr.htm,
"When forage or browse is low in quality, (40% to 55% TDN; 10% protein or less), does in late pregnancy and early lactation should be provided with about 1 lb/day of a 16% protein concentrate." According to the 8th Edition of Merck Veterinary Manual Goat Medicine, does carrying twins have a 180% higher energy requirement (carbohydrates) than those with a single fetus while those bearing triplets have a 240% greater energy requirement. Fat is metabolized into glucose when demand exceeds supply.

The following are signs (in no particular order) to look for when diagnosing ketosis:

1. She may have swelling (edema) of the ankles and lower legs.
2. The doe will lie down a lot; she will become sluggish and slow to get up.
3. The doe will appear depressed.
4. She will have a loss of appetite – eating less and less until she stops eating altogether.
5. Her eyes may appear dull.
6. She may appear stiff.
7. She may walk with a limp.
8. Teeth grinding is common.
9. She may have muscle tremors or seizures.
10. Her breath will have a sweet odor.

Later signs, once the lack of glucose has compromised the neurological system:

1. Blindness
2. Stargazing.
3. Tremors.
4. Ataxia.

Finally the doe will become comatose. According to our vet, around this time the doe's system will kill the fetuses.

The first time you notice a decreased appetite or unwillingness to follow the herd, action must be taken. Exercise should be forced. One source suggested putting the feed and water on opposite sides of the paddock so the doe would have to walk to either; that didn't work for us as our does either quit eating or quit drinking water. Carbohydrates should be increased by offering whole corn, fresh alfalfa, or soybean meal.

Basically you have to recognize the symptoms then (1) hydrate the doe and (2) get enough glucose (sugar) to the brain to wake the doe up.

Research tends to indicate an increase in toxemia during drought or extremely rainy conditions. Please note: the drought may have been the summer before causing hay to be lacking in proper, expected nutrition. Extremely rainy conditions often cause an increase in worm loads which cause the doe to lose enough body condition to become a candidate for toxemia.

While doing research for this article, we learned there is a lot of poor information on the internet – some out-and-out incorrect. For example, according to http://www.goatsprefer.com/ "An adequate nutritional level throughout the pregnancy will prevent pregnancy toxemia. Excessive fat should be avoided." Based on our personal experiences, excessive fat animals are no more or less likely to become ketonic than skinny animals. This site also stated, "The disease usually appears in the last 30 days of pregnancy and is more common after the first pregnancy." Since exactly half of our animals who died of ketosis were in their first pregnancy, I question the source of their statistics. (Admittedly, 4 is a very small sample size to base any conclusion on.)